- The Midlands and North of England Stillbirth Study (MiNESS), published today in BJOG: An International Journal of Obstetrics and Gynaecology, is the largest study of maternal sleep position and risk of stillbirth.
- The study was funded by Action Medical Research, Cure Kids, Sands and Tommy’s
- The increased risk associated with women going to sleep on their back has now been demonstrated consistently by four studies in women of different ethnicities and in different countries.
- If all pregnant women in the UK went to sleep on their side in the third trimester, MiNESS estimates a 3.7% decrease in stillbirth, saving around 130 babies’ lives a year.
- Internationally, this advice has the potential to save up to 100,000 babies a year.
- A public health campaign, the Sleep On Side campaign, led by the charity Tommy’s to educate women about the risk of going to sleep on their back in late pregnancy, also launches today.
- Around 1 in 225 pregnancies in the UK end in stillbirth.
The Midlands and North of England Stillbirth Study (MiNESS) found that women who go to sleep in the supine (lying on the back) position have a 2.3-fold increased risk of late stillbirth (after 28 weeks’ gestation) compared with women who go to sleep on their side.
Led by Professor Alexander Heazell, Clinical Director at the Tommy’s Stillbirth Research Centre at St Mary’s Hospital, Manchester, MiNESS is the largest study to examine maternal sleep and late stillbirth. It looked into 291 pregnancies that ended in stillbirth and 735 women who had a live birth. It confirms findings from earlier studies in New Zealand and Australia that, in the third trimester (after 28 weeks of pregnancy), pregnant women who go to sleep on their back are more likely to have a stillbirth.
Although researchers cannot say for certain why the risk is increased, there are several theories. In the third trimester, when the woman is lying on her back, the combined weight of baby and uterus (womb) puts pressure on the main blood vessels that supply the uterus, and this can restrict blood flow/oxygen to the baby. Other possible explanations include disturbed breathing during sleep, which is worse when a woman sleeps on her back and in overweight or obese women, who also have an increased risk of stillbirth.
The advice to pregnant women is to go to sleep on their side for any episode of sleep in the third trimester, including:
- going to sleep at night
- returning to sleep after any night wakenings
- day time naps
As the going-to-sleep position is the one held longest during the night, women should not be concerned if they wake up on their back, but should simply roll back onto their side.
The MiNESS study did not find a difference in risk between sleeping on the right or left side. One of the previous studies did show that sleeping on the right increased the risk, but as this was not found in the other three studies, the Tommy’s campaign recommends that women can go to sleep on either side.
Professor Heazell says:
“Around 9 babies are stillborn every day in the UK. Stillbirth is devastating, with long-lasting effects on bereaved parents. Parents want to know why their baby has died, whether it might happen again if they try for another baby and what they can do to avoid further stillbirth.”
At the Tommy’s Stillbirth Research Centre, we work to identify what we call ‘modifiable risk factors’ for stillbirth. These risk factors are things in day-to-day life that increase expectant mothers’ chances of having a stillborn baby that, importantly, the women have the power to alter, either alone or with medical help.”
We believe that identifying, and avoiding, risk factors that are strongly associated with stillbirth will reduce the number of babies who are stillborn. The MiNESS results have implications as they indicate that if women go to sleep on their side in late pregnancy rather than on their back there could be 3.7% reduction in stillbirth.”
The four charities, Action Medical Research, Curekids, Sands and Tommy’s, who funded the research have put out a joint statement:
“This research and campaign was only made possible with funding from our four charities, which are supported by parents who have experienced stillbirth. We hope that this information will help parents and reduce the number of babies who are stillborn each day”
Mr Edward Morris, Vice President for Clinical Quality at the Royal College of Obstetricians and Gynaecologists, said:
“This is an important study which adds to the growing body of evidence that sleep position in late pregnancy is a modifiable risk factor for stillbirth. This new research is extremely welcome as a significant number of stillbirths remain unexplained, particularly those in late pregnancy. The impact of stillbirth on parents and professionals is devastating and the RCOG is committed to working collaboratively on research, audit and training for healthcare professionals in order to achieve a substantial reduction in the UK stillbirth rate.”
Louise Silverton, Director for Midwifery at the Royal College of Midwives, said:
“Stillbirth is a terrible tragedy for mothers and their families and we must do all we can to bring stillbirth rates down.
This addition to current knowledge is very welcome. The Tommy’s campaign and the research findings are a great example of how through making small changes we can begin to bring down stillbirth rates. It is a simple change that can make a difference and it will be important to ensure that this is communicated effectively to women.”
Tips for going to sleep on your side in the last three months of pregnancy
- Put a pillow or pillows behind your back to encourage side-sleeping.
- If you wake during the night, check your position and go back to sleep on your side.
- Pay the same attention to sleep position during the day as you would during the night.
NOTES TO EDITORS:
- Participants were recruited between April 2014 and March 2016.
- Eligible women were given a description of the study by their obstetrician or midwife. The participant information sheet stated that the goal of the study was to “look at medical factors associated with stillbirth but also environmental and lifestyle factors that can affect pregnancy and the wellbeing of the baby.” Sleep position was not specifically mentioned in any of the patient-facing literature.
- The Sleep On Side campaign (#SleepOnSide | www.tommys.org/sleeponside) is led by Tommy’s and endorsed by NHS England, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Royal College of GPs.
- The Sleep On Side campaign animation can be viewed here.
For more information and to request an interview with Professor Alex Heazell, please contact Hannah Blake, Press Manager at Tommy’s on E: [email protected] or T: 07730 039361.
Thanks for your interest in our research
Tommy's funds research across the UK investigating the reasons for pregnancy complications and loss. Maternal and fetal research is underfunded and we need your support to continue. There are many small and large ways you can support us, find out more here.
Heazell A, Li M, Budd J et al, 2017, Going-to-sleep supine is a modifiable risk factor for late stillbirth – findings from the Midlands and North of England Stillbirth Case-Control Study
Stacey T, Thompson JM, Mitchell EA et al, 2011, Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ. 2011 Jun 14;342:d3403. doi: 10.1136/bmj.d3403.
Gordon A1, Raynes-Greenow C, Bond D et al, 2015, Sleep position, fetal growth restriction, and late-pregnancy stillbirth: the Sydney stillbirth study. Obstet Gynecol. 2015 Feb;125(2):347-55. doi: 10.1097/AOG.0000000000000627.
McCowan LME, Thompson JMD, Cronin RS et al, 2017, Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PLOS One https://doi.org/10.1371/journal.pone.0179396Hide details
We have received a huge amount of coverage for our #SleepOnSide campaign this week. These are some of the commonly asked questions about the research and the campaign, and our responses.
Nicola writes beautiful and uplifting posts about her experience of losing her first baby, Winter Wolfe, and parenting her second child, Raven Rain. Here she explains why she’s supporting Tommy’s Sleep On Side campaign.
We showed the Sleep on Side campaign and research to some well-known mums and filmed their reactions.
A filmed presentation about the four research studies into maternal sleep position and pregnancy that led to the Sleep On Side campaign. Featuring Professor Alex Heazell.
This film has been developed with women and clinicians as part of the Sleep On Side campaign to raise awareness of this important message.
Today we are launching a public health campaign, #SleepOnSide, to raise awareness of the link between the mother sleeping on her back in the third trimester and stillbirth. The fourth research study to show this link also publishes today.
In the third trimester of pregnancy going to sleep on your side has been shown to help prevent stillbirth.
By Pepi (not verified) on 7 Mar 2018 - 22:38
Can small bursts of lying (i.e. less than 15mins) on your back be problematic as well? Is there anything in this research that suggests that?
By Midwife @Tommys on 9 Mar 2018 - 10:24
The research looked at the sleep position when women fell asleep. Best advice is to avoid lying on your back even for short periods of time. For many years we have been aware that examining women on their backs was problematic and we keep the length of time needed for this to a minimum.